We’ve written about post-traumatic stress disorder (PTSD) in a previous article, which is a debilitating condition that affects the mind, body, and spirit, related to the failure of what scientists call the brain’s “extinction process,” which dissolves the impact of the memories created following a traumatic event.
Often PTSD results from either witness or direct exposure to an event that is perceived as traumatic, with the condition being characterized by symptoms such as nightmares, anxiety, flashbacks, and depression, and it is occasionally accompanied by alcohol or substance abuse as the individual attempts to relieve themselves of the pain they are experiencing; they don’t know how to process and deal with the trauma that occurred, so they find themselves reliving the event, in a way, numbing themselves with substances, and falling into addictive behaviors. Addiction, as defined by Dr Gabor Mate, “is manifested in any behavior that a person craves, finds temporary relief or pleasure in but suffers negative consequences as a result of, and yet has difficulty giving up." In brief: craving, relief, pleasure, suffering, impaired control. Veterans with PTSD can be at a higher risk of developing high-tetrahydrocannabinol (THC) cannabis dependence, and much of the research has focused on this, despite the large amount of reports that cannabis was able to provide relief from the symptoms. New research has revealed and confirmed that cannabidiol (CBD) can potentially aid in treating symptoms of PTSD effectively and safely without psychoactivity and underscores a link between the endocannabinoid system (ECS) and the processing of traumatic memories in the brain.
Recent research shown a reduction in circulating endocannabinoid levels in people with PTSD. A study from 2013 involving individuals who were exposed to the World Trade Center attacks, had the authors conclude that, “this data supports the hypothesis that deficient eCB [endocannabinoid] signaling may be a component of the glucocorticoid dysregulation associated with PTSD.”
The endocannabinoid system (ECS) is a unique system of physiology present inside every mammal, including humans, that is responsible for maintaining order and balance across all major organ and bodily systems. It truly is, the Wizard of Oz, pulling all the strings. The trouble is, when this system becomes overwhelmed from stresses placed upon it, such as in the case of the individuals bearing witness to the World Trade Center attacks, without adequate support (for the people and for their ECS), the ECS can quickly fall into a state of disorder, unable to perform its basic tasks, leading to disruption, imbalance, and disease-like states throughout the body. Cannabinoids found inside the cannabis (hemp) plant work through and with the ECS to help support its healthy functioning. This is one reason why we see such promising results with CBD, THC, and other cannabinoids like CBC, CBG, THCA, and THCV. For more information, see our article, The Endocannabinoid System Explained.
Even the United States Department of Veterans Affairs acknowledges on its website that the link between PTSD and the endocannabinoid system has been clearly demonstrated and that cannabis may help with symptoms in the short term, but warns about the long-term risks of addiction to high-THC cannabis. It does state that cannabidiol (CBD) has been shown to be very effective at treating anxiety related to other causes, but that the research on its use for treating PTSD is not completely clear or adequate yet, and that further studies are needed.
It is suggested to work with a healthcare professional that is experienced in recommending medical marijuana or CBD to treat depression so the delivery and dosage may be worked out appropriately. Along the same lines, educated and aware people may become their own highly informed health consultants. The information contained in this article is for informational purposes only, and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, consult with your doctor.
As always with medical marijuana, start with a micro dose to test for sensitivity and titrate up as needed until symptoms subside. A micro to standard dose is typically the go-to for assisting with PTSD. Cannabis varieties that are high in the terpenes myrcene and linalool, a terpene that is also found inside lavender, can elicit a more potent relaxing effect and also help with getting a restful night's sleep. For more information, see our guide on terpenes.
CBD products made with indica-dominant varieties that are higher in tetrahydrocannabinol (THC) can also be advantageous for sleep issues (see our article on sleep), or can also produce a sedating, calming, and anti-anxiety result, perfect before bed. A maximum dose range of 5-10 mg of THC per administration is generally suggested. Be sure to avoid cannabis products containing sativa strains as they can promote dissociation and hyperactivity. High-CBD products with a ratio above 20:1 should be tested first to prevent too much psychoactivity from THC. If this doesn’t help bring relief to symptoms of PTSD, THC can be added into the protocol slowly, working up towards a 1:1 ratio.
Although high-CBD products can help some individuals sleep, for others, it can make them more alert and promote wakefulness (cannabis strains and ratios can have a bidirectional effect; relaxing some, and creating more alertness in others, so experimentation is needed). When THC is taken orally, especially from marijuana strains with heavier broad-leaf indica “Kush” strains and purple cannabis varieties, it can be very effective for sleep disorders. These strains tend to be higher in the terpenes myrcene and linalool, associated with lavender, and known for its relaxing stress relieving qualities, often used in essential oil products.
The cannabis strain, pineapple express and blue dream are often sought after by PTSD patients. A 1:1 ratio of CBD to THC can be utilized when people experience too much psychoactivity, as CBD neutralizes the psychoactive effects of THC, or at minimum, greatly reduces it. This is especially helpful for those experiencing pre-existing anxiety.
For immediate relief, smoking or vaporizing works well. This can be of value for wakefulness in the middle of the night or in a rest period, but only lasts one to three hours. The effect from delivering the plant this way is immediate, whereas with most ingestible products, they can take thirty to sixty minutes before kicking in (can be quicker on an empty stomach) and last six to eight hours. Vaporizers utilizing a cartridge filled with CO2 concentrates are very effective, and they typically come in various ratios of CBD content to THC. Herbal vaporizers that use a whole plant strain are also an effective delivery method. Sublingual sprays or tinctures taken as liquid drops also take effect quickly and last longer than inhaled products.
When high doses are needed, many people will use concentrated forms of cannabis oil and consume it orally, by adding to food (mix in with nut butters), or in capsule form. The most potent and purest concentrates are made using CO2 extraction.
The Cannabis Health Index is a scoring system for cannabis (in general, not just high-CBD strain) and its effectiveness on various health concerns based on the best available evidence to date in the medical literature. For the treatment of PTSD, cannabis rates in the possible-to-probably range of efficacy (2.8 points out of 5).
A study from 2016 reconfirmed the antipsychotic properties of cannabidiol (CBD) in relation to schizophrenia and identified the main mechanism for its function in the brain, which is closely related to that of other pharmaceutical drugs prescribed for PTSD-related psychosis. Researchers concluded that, “CBD can produce effects similar to antipsychotic medications by triggering molecular signaling pathways associated with the effects of classic antipsychotic medications.”  Research from just a few years before showed that CBD was just as effective as regularly prescribed antipsychotics and had far fewer side effects. 
In research from 2018, scientists suggested that, “CBD may offer therapeutic benefits for disorders related to inappropriate responses to traumatic memories. The effects of CBD on the different stages of aversive memory processing make this compound a candidate pharmacological adjunct to psychological therapies for PTSD. CBD also shows an action profile with fewer side effects than the pharmacological therapy currently used to treat this type of disorder.” 
Interesting to note that they proposed CBD could be utilized as a supplemental therapy to “traditional” forms of talk therapy, such as psychotherapy, cognitive behavioral therapy, counseling, and so on. This would bring a more holistic approach to the individual as a whole, encouraging the individual to work through the trauma on multiple levels, which could create the potential for true and long-lasting healing.
A study from 2019 showed very promising results from CBD administration with 91% of adult patients experiencing a decrease in PTSD symptoms after just eight weeks of treatment. CBD was generally well tolerated, and none of the participants stopped treatment due to side effects. Researchers also noted that, “CBD also appeared to offer relief in a subset of patients who reported frequent nightmares as a symptom of their PTSD.”  Additional research from 2019 also acknowledged the benefits of utilizing cannabinoids in PTSD,  with a meta-analysis further encouraging clinical studies to be completed as soon as possible. 
Two very recent studies also reveal how cannabinoids could assist with PTSD. One study involving the use of THC shows how cannabis can reduce activity in the amygdala,  which is a part of the brain associated with fear responses to threats. Researchers stated, “that THC modulates threat-related processing in trauma-exposed individuals with PTSD.”
The other study has revealed that cannabinoids found in the cannabis plant could play a role in extinguishing traumatic memories.  Both effects could be therapeutic for those suffering from PTSD. After going through the medical literature, researchers discovered that cannabis could assist with PTSD. Low doses of the cannabinoid THC, or THC combined with CBD, were both able to enhance the extinction rate for challenging memories (as mentioned earlier in this article), and reduce overall anxiety responses. From the research, it seems that THC drives the extinction rate improvements, while CBD can help alleviate potential side effects from higher doses of THC.
The authors conclude that the current evidence from both healthy humans and PTSD patients suggests that these forms of cannabis “suppress anxiety and aversive memory expression without producing significant adverse effects.”
For more information, see our previous article on PTSD.
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